Getting help from counselling and therapy for domestic violence and abuse

Research shows that women who are in or have left an abusive relationship experience a higher than average level of anxiety, depression, panic attacks and post-traumatic stress disorder (PTSD). Many women can find it difficult to deal with the emotional and psychological impacts of abuse and the ways in which it can continue to affect their lives and relationships with others over time. Some women report finding it very hard to talk to doctors about problems at home (See ‘Getting help from doctors and other health professionals for domestic violence and abuse’). They also report feeling guilty about accessing support services after they have left a relationship because they feel such services should be available for those in crisis. We also know that many women who leave an abusive relationship suffer financial hardship which makes it difficult to access private counselling or therapeutic services. Research suggests that psychological help for women who have experienced abuse can help to improve their well-being. In some cases, they may be referred by their doctor for a course of general counselling or, if abuse has been recognised, to a Domestic Violence and Abuse Agency. For some women, like Anna, receiving counselling was crucial in their recovery from the trauma of abuse. Anna said:

‘The physical side can heal but the mind controls everything and I need to heal the mind’.

Most women felt the same, and some commented that this kind of healing may take a long time. Anna’s husband used to put pillows over her face and tell her she would die. She received counselling via the police and also from her local Domestic Violence and Abuse agency.

Anna is a single, white British woman. She lives in a council property with two of her six children, one of whom has special needs. She works part-time as a volunteer for two charitable organisations.

Yeah, It reopens the one, those, you get those periods of it all reopening, it’s hard to get through that because it’s, it’s you re, re-live it. You re, re-live the fear, you re-live the anxiety, the nightmares.

Yeah.

It’s a daily whole consumption thing. It’s hard.

So it’s still something you’re having to live with, this …

It’s something I still live with today. I mean, I’m hoping now with the counselling and it’s 20 weeks counselling …

20 weeks.

… so, and I am taking it all on board, everything. So, one of the handouts was about a memory box, and create that, so I’ve done that. And I’ve got an old box of photos and I’ve gone through them and I’ve actually got, because all around my house is photos of my children everywhere. And now I’ve actually got, on top of a chest of drawers that I go past everyday I’ve photos from the past that represent good memories.

OK.

Because I have to remind myself there are good memories from the past.

Yeah.

They might not involve him but I, there was a life before him …

Yeah.

… and there could be a life after him.

It’s kind of keeping those, those …

Yeah.

… those up there. And it sounds like the abuse has sort of had a great effect on, on how you think and feel about yourself.

Yeah, that’s still an ongoing…

Ongoing.

…process.

Most women started receiving counselling only after they had left their abusive partner, as part of the process of recovery. Their accounts showed how important it was to get the timing right for counselling, since it’s a bit like ‘opening Pandora’s box’.

Chloe is a 32 year old single white British woman born in South Africa. She lives on her own in a council flat. She works as a Holistic Bodywork Therapist but was unable to work at the time of the interview owing to Post Traumatic Stress Disorder (PTSD), which developed in the aftermath of an abusive relationship. Chloe is single with no children.

You mentioned when we spoke on the phone that you had PTSD diagnosed, when did that come about?

It’s fairly recent actually. It’s not, I mean I was struggling with anxiety and, well, what was labelled as anxiety and depression which turned out to be PTSD really. It was just kind of waiting for all the symptoms to pop up and just…

What help are you getting with that?

…at first I was not able to have any counselling or anything over this period because I – what they said to me was, “You need to be stable, you need to be safe to open up,” and I wasn’t, I was couch surfing.

Who was saying this to you?

The [Domestic Violence and Abuse agency] workers or?

It was, it was [Domestic Violence and Abuse agency] workers and anyone else I’d been referred to for therapy, [local charity] I think was one.

Yeah, yeah I’ve heard of them.

They were all saying the same thing, “We can’t open it, it’s Pandora’s box, you know, until you’ve got – you know, you’re too unstable basically to do this.”

Right.

Which was agony, because the box was already open. But they were right, because I was being triggered left, right and centre from not having a stable home. so I’ve been here three months, and we’ve just started opening that and I’ve had a few therapy sessions.

Right.

It’s kind of like finding the right therapy as well because…

Of course yeah.

…at the moment the therapy I’m having is for domestic violence.

Right.

It’s looking at, it’s also looking in the direction of self-harm and eating basically. Because I now have a very weird thing to do with eating: the extremes of eating healthy and, you know, eating the things that are [unclear] make you space out and go away. And it’s only the beginning of that so…

Right yeah, and that’s from someone with a speciality in domestic violence counselling, yeah?

Hmm so really I need the PTSD person. They cost about £95 a session.

This other counselling, are you having to pay for that or is it available?

That’s also through [Domestic Violence and Abuse agency]. So I can only be referred for that once I’ve finished what I’m doing. I can’t do two at the same time.

OK.

So yeah, I’m actually pretty scared at the moment where I’m thinking this is not quite the right counselling, but I don’t really know what I need [laughs], you know, enough to just keep following and hopefully come to the right people.

Women’s anxieties about getting psychological help

Women we interviewed had mixed feelings about psychological help. Some women felt anxious about having any psychological support or treatment because their abusive partner might use this against them, as evidence that they were ‘mad’ or an unfit parent (see ‘Coercive Controlling Behaviour’). Women were also fearful of any kind of mental health assessment in case it went on their medical notes and resulted in them losing their children. When Tanya’s partner attacked her daughter she had to put these fears aside and she went to see her doctor. She had a mental health assessment and, while waiting for the outcome she was terrified of her kids being taken from her and her husband finding out she had talked to someone.

Tanya is a 45 year old white British woman who lives with her three children in a rented home. Educated to degree level, Tanya works part-time and also volunteers for a domestic violence and abuse charity.

Went to see a GP on the Tuesday. She decided - told her everything about the attack on my daughter.

Did you tell her about the abuse that you had sustained as well?

Can’t, can’t remember. I think – I can’t remember, don’t know. Probably said he’s always been horrible, I would imagine. And went to – I mean obviously I was terrified of telling anyone else at this point. Absolutely terrified I’d get the kids taken off me, I was scared he’d kill me if he found out I was telling anyone, but I did it because I had to. So the GP, she got a mental health assessment done on me. That was the first thing she wanted done. So I was waiting in absolute terror for a letter to be – come – to post – to be posted out to me while I was still living with my husband about my appointment for a mental health assessment. Anyway, luckily, I got the letter before my husband found, got it. Otherwise I – what would have happened, I don’t know. Well, he’d have been horrible and evil and oh terrifying. So I got the letter, went to the assessment, terrified when I was having my – talking to this mental health professional, terrified that my husband would know. Plus I remember he was at home, and obviously I’d had to make up that I was going, I don’t know where I said I’d gone, but I’d had to lie to him. And you couldn’t lie to him because he’d wheedle out, he’d just terrify you that he knew, yeah, what was really happening, what you’d really done or something. So I oh yeah, I was terrified. Anyway, went to the – anyway, she, the health professional, mental health professional, the report came back to the GP and the recommendation was I was not mentally ill, so that was good. So I was quite relieved.

They had to assess you, she felt that she had to assess you…

Yeah.

…before even?

Yeah, nothing else had happened. The police weren’t phoned, nothing, nothing, nothing like that. And the mental health professional had suggested that I needed to get in touch with the local refuge, that was the outcome.

Right.

So it was obviously it was, it was decided that we were suffering domestic violence, I wasn’t mentally ill and I needed to now get – so this was a couple of weeks after he’d, he’d battered our daughter, you know, that’s how long it had taken. So I went to the refuge. My very good friend, who was the safeguarding lady, she took me.

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Age at interview:

46

Sex:

Background:

Catherine is a white British woman who lives with her new partner in their owned home. Catherine is doing postgraduate study at university. She has two sons, both in their 20s.

And you accessed counselling, you said, through your GP. And that was when you were in your 20s?

Yeah. I’ve been through several rounds yeah.

Who else has that been through? How else have you accessed the counselling?

I’ve done it twice through staff counselling here, and only just finished. Well weirdly enough I only just finished the last round about a month ago, because one of the last things I talked to her about was the fact that I was going to come and do this...

Yeah.

... and I said, “Oh, you know, it’s a really good thing and I really want to contribute to it but actually I’m not really quite sure [laughing] what it’s going to do.” So she said that I can go back and see her for an extra session that I’m not really entitled to but she said, “You can have another session if ... if you feel like you need that after this thing.” So that was really good of her actually. So...

And how helpful or unhelpful has the counselling been that you’ve received?

This last one, much, much more useful than before, and I don’t know whether it’s because it’s a different person or whether I’m just in a different headspace now. When you talk about the biggest impact that all that stuff had on my life, I would say now the biggest impact that it’s had is that it’s kind of woken me up and, you know, I just ... I look at everything before it happens now. You know, the minute I start finding myself burying my own feelings or trying to placate people or running around after people, I just stop myself and think, “What you doing? What you doing? What you doing?”

Yeah.

So actually I think, in the end, it ... I ... you know, I’m turning it around and using it to inform ... actually making a choice about what I do in the future, and I thought, you know, I am not going to get into another relationship when all I’m doing is, you know, pouring oil on top of water all the time and being nice to somebody...

Yeah.

... and ... because I did start dating a guy that started chatting me up in the pub, you know, and then I suddenly after a bit it was like, “Oh, I’m doing it again.” And then ...and I broke up with him and for the first time I just thought, “Actually, I don’t feel a shred of guilt about doing that, because I know it was exactly the right thing to do.”

Yeah.

And, you know, when ... when [Name] and I met, you know, and when there was things that, that I wasn’t happy about I forced myself to talk about it and say, oh, you know, “Can we do this?” or...

Yeah.

... “Can we not do this?”

General psychological counselling

Many women were referred by their GPs for general counselling for depression, anxiety and sleeping difficulties. The majority of women said that six weeks of general counselling was too short, and not always helpful without a specific focus on domestic violence and abuse. However, even though their counsellors were not specialists in domestic violence and abuse, both Mandy and Charlotte had breakthrough moments.

Mandy is a white British woman who is educated to degree level. After a period off work with depression, she now works full-time and is currently living with her new partner and dogs.

I think I realised that I had serious problem in the sort of September/October last year. I thought I was depressed, I wasn’t sleeping. I was having a hard time at work as well. I went to see my GP and she prescribed me antidepressants and signed me off for two weeks. She also put me forward for counselling because I said I felt like I was depressed and I was really struggling at work, it was having a negative impact on me. And I think it was the counsellor that first sort of flipped the switch in my head, and I thought, “Oh my God, she’s actually right”, and suddenly everything made sense. It wasn’t me that was depressed, it was him, and because of it he was making me miserable. As soon as I actually ended it, I felt free.

And he kept texting, and he kept emailing, and I was responding. And the counsellor said, “Stop it, because whenever you respond he’s going to come back to you”. And we likened it to a boomerang. If you don’t pick it up and throw it, it can’t come back and hit you on the head. So I stopped and he went quiet for a while, and then it started escalating. He just didn’t want to let go. I didn’t see him, but he started sending me texts saying that he was going to end it all…

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38

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Charlotte is a White British woman who lives in her privately owned home. She has three daughters, aged 11, 15 and 16 years and she works part-time as a teacher.

And then I went, I had another session with my counsellor who actually, she was the person who flagged up the whole domestic abuse thing for me in the first place.

OK.

When did I first go and see her? I can’t remember. Probably a couple of years after my dad died, because I wasn’t handling my grief properly. I wasn’t grieving properly, I was still being really miserable, I was still banging on about missing my dad after all this time and it wasn’t working for him, so I needed to go and get some bereavement counselling. So I dutifully went off and got some bereavement counselling.

Was that through your GP or was that private?

That was privately. So I found this woman who just was local and she looked nice and she sounded good. So I went to go and see her. This must have been a year before we broke up, maybe even a year and a half before we broke up. It was about a year and a half, I think, before we broke up, I went to go and see her. I’m trying to remember my timelines. I went to go and see her. So I had my first session with her, which was kind of, you know, background history, you know, “Who is your family? What is your support? Why are you here?” all those kinds of questions.

Yeah.

So that was that. I went back to see her the following week for my second session and she handed me, can’t remember what it was called, ‘The Wheel of Control’ or ‘The Power Wheel’ or something. It’s this, like a visual of different ways in which people can be controlled. So she handed me that and she said, “I just want you to have a little look at this and see what you think, you know. I just wonder if there’s anything on there that might speak to you.” So I sat down and I looked at it and I was like, you know, “There’s me thinking I’m here for bereavement counselling.”

Yeah.

I was looking at it and she said, “Just, you know, have a look at all the different segments and tell me if you can relate to any of them.” So I looked at them and I said, “Yeah, I can.” And she said, “Well, how many of them?” I said, “Well, all of them.” And she went, “Right,” and she said, “well, from some of the things you were saying last week I thought there might be a couple of things on here, but that’s a lot worse than I had realised. Talk me through it.” So as I started talking her through it, pennies started dropping a little bit. “Hang on a second, are you telling me that this isn’t normal? You know, are you telling me that all of these things I’ve been living with, thinking that’s just how men are, this is just how a marriage is, this is just what is expected, am I wrong?” So that was, that hit me like a train. That was quite hard to acknowledge. And from that point I then went and saw her a few more times. She wasn’t a specialist in domestic abuse at all but she was able to kind of talk me through, or help me question why I thought any of those things were OK. Would I accept that kind of behaviour from a friend or from a family member? If not, why not? Why did I then accept it from him?

Just those kinds of things. She was really gentle and she didn’t kind of tell me what to do. She was just helping me open my eyes. And as that started happening, I could – you know, he was still being horrendous at home and getting worse and worse and worse. I was starting to realise and see what was going on in a different way. I was becoming more and more detached from myself and my life and my family, just shutting down completely.

* The Duluth model which includes the Power and Control Wheel is an approach to challenging abuse which underpins many other services (see our resources).

Women like Khalida, Jessica and Jane had specialist counselling from a domestic violence and abuse agency. They found it really good, as the counsellors had an understanding of the impact of abuse such as trauma, flashbacks and nightmares. Jane said it ‘helped tremendously’ and Jessica compared the specialist abuse counselling favourably with the general counselling she had received.

Jessica is a single retired white British woman in her fifties. She has lived alone for three years since leaving her abusive marriage of 27 years. She has two adult children. She was employed until she developed fibromyalgia.

I did counselling with [local domestic abuse agency], at, that’s the best counselling I’ve ever had.

Ohh.

But unfortunately they can only give you so many sessions and that’s with a counsellor that knows everything about abuse and she just understands where you’re coming from all the time. And …

Was that you got that because you was, you were in a refuge belonging to [specialist domestic abuse service], it’s like a partner organisation, [local mental health and housing association for women].

That’s right, yes. Yes.

And in what ways did you find that helpful?

It, it was just a way of, you can, you could talk to and she could relate to everything that you’d been through. Because I think that other counsellors, they’re good but they, they don’t know about abuse in the way that you have if you’ve been through it.

Have you had experience of other counsellors who don’t really know about abuse?

Quite a few, yes.

Have you?

Yeah, Yeah.

What type of counsellors? For example, were they through the GP or …

Through the GP and private agencies, yes.

Hm. And did that, from what you’re saying, has that been less, less helpful for you?

Less helpful yeah.

Hm.

Yeah.

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58

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Background:

Khalida left Pakistan aged six to settle in the UK with her parents. Now aged 58, she is separated from her husband, living in temporary council accommodation with her youngest son, aged 15, and is unable to work owing to vertigo. Three of her adult children live in the same city.

Have you had any therapy that’s about domestic abuse specifically or is it just general?

This one is, it is, this one they sent me. This one is Women’s Aid. They have sent me to because the other, the other one is just APT, IAPT.

IAPT yeah.

For seven weeks I had with…

And that was helpful, was it?

It was helpful. She made me realise a lot of things. But, because I’m very forgetful, I forget everything, I’d forget my head if it wasn’t stuck on, it’s one of those things. And talking to her, it helped me.

Right.

It helped me realise the things that, you know, things that hurt me, things that are going in my head, all the flashbacks and the, and the nightmares I have. They subsided when I started talking to her. Because I think it’s just talking about it helps.

Some women were offered group therapy by Women’s Aid. Ella could not attend as she suffered from bad panic attacks, and instead she received therapy at home. Philippa found group sessions while she was in a refuge were sufficient for her to ‘get over’ the abuse and ‘move on’.

Several women wanted to work at improving their relationship with their partner, and they went to RELATE (formerly known as ‘Marriage Guidance’).

Shaina is a 32 year old single woman with mixed French and Mauritian origin. She lives in a privately rented house with her three children aged ten, eight and six years, and works part-time as a school lunchtime supervisor.

And during that time we had got onto, I think it was Relate, for relationship counselling.

Oh right, how had you got on to them?

I really can’t remember how we got there, to be honest with you. But we had three sessions.

And your partner went with you?

He went, he did, and this is when we discussed baby number three was coming. He came to terms with that through the counselling.

Right.

So he was OK about then having the child. Then we discussed the physical violence. And the counsellor said that he needs to learn a mental state of mind. Where he knows he’s getting angry, he needs to learn to walk out of the house.

Right OK.

It never happened.

But he was able to talk about his violence in front of the counsellor?

Yeah, he was. He did discuss it and he even his mum knew, even his dad knew. They used to talk to him. So he was quite – I think – I don’t know if he acknowledges that he has a problem.

Right.

Yeah.

Shaina was also referred for by the local domestic violence and abuse agency for family therapy with her children over two to three years, after the abusive relationship had ended, which she valued.

Kate is a single, well-educated, white British woman who lives with her two young children in their privately owned home. She is currently unable to work due to anxiety and depression.

After one particularly bad verbal abuse sort of explosion where he stormed around the house for about 45 minutes punching things, smashing, slamming doors, kicking toys, hurling loud angry abuse at me in front of the children, including threatening to kill himself and threatening to leave and - telling me that I’m, shouting at me angrily that I must be sleeping with somebody else because I wasn’t sleeping with him and although he used worse language. And you know, and the children are listening to all of this. It was terribly wrong. And after that I said, “Right, we need to go to [marriage guidance] or we need to break up, because this is intolerable. We can’t live with this happening.” [Marriage guidance] gave us a session very fast when I explained the situation. We were there within four days. And he, the therapist questioned us very closely, asked me for my version of events about why we were there, crosschecked with my partner repeatedly that he agreed with what I was saying, which he did. And then about half way through the session stopped and said, turned to my partner and said, “This is categorically domestic abuse. This is domestic violence. It absolutely has to stop. You’re breaking the law. There’s utterly no question about this.” And he then talked about safety going forward, how my partner needed to manage his anger before we came back to see them again, and explained that if there was any further incidents of abuse reported that he would have to report us himself and then we left. It was a very shocking session. Although I’d suspected that was what was going on, to have it put into black and white like that and have it said to my partner with absolute finality and certainty was quite frightening and shocking. And then of course the problem was I had to go home with him and he was angry. He was angry at what I had done to him, “Look what you’ve done to me now. You’ve given me this label. Now I’m going to be labelled an abuser. I might as well tattoo it on my forehead. This is all your fault. Why would you want to do this? Why are you doing this to me? Why are you doing this to us?” It was like it was nothing to do with his behaviour and his choices. The whole thing was, you know, because I’d told to somebody, that I was doing this. He raged for over the whole weekend. It was a dreadful weekend. I was very frightened. I didn’t sleep. The children were on edge. He was just livid.

Several women were diagnosed as having post-traumatic stress disorder (PTSD). This diagnosis helped Sophie to eventually access EMDR (Eye Movement Desensitisation and Reprocessing therapy), which is recommended for trauma, free of charge via her local Depression and Anxiety Service. She said how hard it was initially to access services unless you have ‘significant mental health issues’. She also commented on the difficulty in accessing services when, like her, you live in a rural area. Sue said her ‘best help’, was from her mental health team, which included EMDR. Her experiences of counselling from two women’s agencies was mixed.

Sue is a 52 year old white British woman, divorced and living with her son aged 20, in the home of an elderly relative for whom Sue is the full-time carer. She has a 23 year old daughter at University.

So, you were saying your GP was helpful. Did ..…

Yes, she was.

…did you talk to her about the relationship and the abuse or?

Not, not the actual things, no.

No, but she, you mentioned ‘a relationship’?

Yeah…

Yeah.

…and she recom, she, what’s the word, made a referral…

Yes.

…to the, mental health people, [local mental health centre] people…

Right.

…it’s EDMR, I think it’s called.

How long did you see them for?

Well I found, I’ve just, I’ve actually I am still seeing them…

Right.

… but, I’ve had to postpone it for a bit, because obviously I’m down here with my but I did go to the Women’s Centre, to have counselling at the Women’s Centre.

Local to where you’re living now?

When I was back up at, living in [name of town], yeah, after I’d seen the GP, and I asked for a lady who was of similar age because I felt that the younger woman I don’t know. And basically I just sat there and talked to her, she never said a word, but I felt like she helped me millions [laughter] absolutely loads…

Yeah. And that, do you have a number of appointments?

Yeah, about twelve at the, …

Right, OK.

…the Women’s Centre, and I’ve found that absolutely, really, really, really helpful, really helpful, and then I’ve been seeing somebody, through the mental health team.

Was that one to one as well?

Yes, yeah, and that, she does the tapping thing and…

I’ve heard of that yeah.

And it’s really, it’s been …

Do you find that useful?

I have…

Yeah.

… found it useful, yeah…

Yeah.

… I have found it useful. We’ve gone over a lot of things, and I, and I don’t always feel, oops sorry, I don’t always have that feeling, I can talk about things without feeling sad about it, or feeling upset about it sometimes now.

Both Melanie and Julia received a range of therapies, including cognitive behavioural therapy (CBT) to help let go of bad memories of abuse. They learned self-help techniques to manage flashbacks and nightmares.

Melanie is 42 year old, black British (Caribbean) woman, single and living with her daughters aged 22, 20 and seven. She is a support worker for people with learning disabilities, but has taken time out from work, to care for family and to recover from a depressive illness.

Is that CBT specifically for women who’ve experienced abuse, or not? It was just general?

I think it was I was what do you call? I was in panic, a, traumatic …

Yeah.

Post-traumatic stress disorder.

Right.

Yeah.

Right. OK. And, and did you get something from it? So, I mean, you explained that you didn’t really understand it but did you …

I did get something from it.

Hmm.

I think I, for a lot of my time I’d been living in my abuse still for many years, I think, and I took it from one relationship to another relationship, to another relationship, and I would give them all my story and they would use those things to hurt me. And I realised that I’m not living in that …

The men, not the therapists?

No not the, yeah.

Men [laughs]

Not the therapists, yeah, the men. So I realised I was still living in those moments and what the CBT taught me is that you’re no longer there. And it’s taught me to, you know, I, if I get flashbacks, it’s taught me some strategies to use. Some breathing techniques as well. And to write things down. So, yeah, it has taught me, it’s taught me quite a lot.

And how many sessions did you have of CBT?

I think I had 12 as well, I think I had 12 sessions. Yeah. Yeah.

And then since then you say you’ve also been having a different kind of therapy?

Yes.

From?

[Name of sexual abuse counselling centre]

I don’t know [name of sexual abuse counselling centre] either.

I don’t know.

OK. It’s an organisation

It is an organisation, yeah. But this is through the Freedom.

Ahh, OK, so Freedom put you onto them?

Yes. Yeah. And they, they come to the actual programme where I am, so they see me on-site.

OK.

Yes, they come to see me.

And it’s one-to-one?

It is one-to-one, yeah.

Yeah.

Yeah. I’ve only just started that one.

Do you think it’s going to be helpful?

I think so. What, the session that I had last week was quite powerful.

* The Duluth model which includes the Power and Control Wheel is an approach to challenging abuse which underpins many other services.